Emg test

[SAMMY88]

Hi all, I've got a weird question, when you had an emg test ( the needle part) did the neurologist/ technician move the needle about quite aggressively from side to side in the muscle part between your thumb and forefinger ? I cant seem to find out why that would happen anywhere on the Internet.

[shelly21]

I really can't remember but I got tested everywhere and it was sore at times.

[Ellie]

Don't read anything into how the Neurophysiologist moved, or didn't move, an EMG needle (nor any noises or lack of, nor how long the needle was, or was not in, a particular muscle) as, unless you asked the question during the test itself, it's impossible to know why a needle was moved in a certain way months or years later.

I certainly had some electrodes moved once in, others were not.

What matters is the result and how they correspond to clinical findings.

[SAMMY88]

Ellie, Dam girl you are so rational, I get the feeling you know exactly where I was going with this. Can't blame a girl for dreaming 😏.

I just didn't trust the person who preformed the emg test. She was so excited about finding something but refused to tell me. She put needles everywhere, even in the side of my neck but only some of the muscles were included in the emg results, the neck muscles missing. The emg results said strong support for anterior horn cell disease. So obviously I want to prove her wrong .......😬

[TinyLady]

SAMMY88 - mine was moved around a bit. I remember because it was very uncomfortable!

[Arcadian]

Yes

[Ellie]

I get the feeling you know exactly where I was going with this.

I do but you have a host of valid reasons to have genuine doubts, not least because of the subsequent disgraceful cloak-and-dagger treatment...

Now it's my turn to say that you know exactly where I am going with this 😉 and, to be fair I know from chatting to you that you're trying to, but you really, really need to get that all-important 2nd opinion or, in my opinion, to start over from scratch in a specialist MND Clinic.

Yes, I know it's a pain but you really, really need to know for sure if you have, or do not have an MND. Difficult though it will be, chase up an appointment because, you know what Sammy, you're worth it. xx

[Christopher]

Hello SAMMY88 remember that the Neurophysiologist is just a service provider for the Neurologist. They are providing some information in the same way as the person who takes your blood sample or who does your x-ray. They are not charged with making a diagnosis.

I know this is all very frustrating. Over the years I have had three electrical spikey tests. Each time I have said to the person carrying out the test, "is this a science with a precise outcome". Each time I have been answered with "no". Most will admit that it is something between an art and a science. I liken it to a radar. You can see a shadow on a screen, but you have no idea what it is.

So to lighten the mood on my last test I said could he spike me to make my fingers move on my left hand, or my feet to flex

As you know MND is a diagnosis by exclusion. So they look to exclude lots of other things before getting to the final clinical diagnosis.

If you read the clinical papers you will see there is great variability in using the Neurophysiologists tools as reliable diagnostic markers for MND.

There are some studies which show that ultrasound is a more reliable diagnostic tool.

This is why the Neurologist needs to look at the whole clinical picture. In fact the Neurologists at one large teaching hospital which takes patients from around the country wrote to a medical journal saying that there was no need to take information from Neurophysiologists as it was a clinical diagnosis.

They are now also saying that a high CRP is an early indicator of diseases severity. Something that I had never thought of before (it is an inflammatory marker) (for example my CRP had been 280, it should be below 10).

As Ellie says its important to get a second opinion, or even a third.

We all have different diagnostic journeys.

I was diagnosed a number of times in different places, each time ignoring it.

It was only when I ended up in hospital yet again and all the services jumped to it that I realised that things were getting too much (and when two different doctors write and say "rapidly progressing").

I hope that you find the right diagnostic pathway.

Yes I am upset and frustrated both with myself and the medics that I saw many years ago when I started having issues. I always just thought it was my back causing me problems (and the cyst on the brain). The problem is, other issues can mask MND.

Good Luck.

[Christopher]

BMJ (British Medical Journal)
"We suggest, however, that EMG is neither ‘essential’ nor ‘diagnostic’ for motor neurone disease (MND). Rather, for at least the 85% of cases with classical amyotrophic lateral sclerosis, MND is a clinical diagnosis."

Professor Martin Turner, Clinical Neurology, West Wing Level 3, John Radcliffe Hospital, Oxford OX3 9DU

[Ellie]

I liken it to a radar. You can see a shadow on a screen, but you have no idea what it is.

With an EMG, there is much more information gained than a mere shadow on a radar: the type of aircraft, the number of engines and thrust generated and its cruising speed are all clearly identifiable, what's missing is the flight plan which the pilot has determined 😏😄

[Christopher]

Professor Martin Turner
PROFESSOR OF CLINICAL NEUROLOGY & NEUROSCIENCE


"There is no test for MND, so diagnosis relies on the opinion of an expert neurologist, and any investigations are currently only to exclude other possible causes for the same symptoms (of which there are not many). Biomarkers might be able to shorten the delay of up to one year that many patients with MND have to wait to get a firm diagnosis. This might allow potential therapies to be introduced earlier, before there is spread of symptoms to more than one body region. It would also allow drug trials to be organised more efficiently, by categorizing patients according to disease activity, and making decisions about efficacy much sooner"

[SAMMY88]

Ellie, Thanks Ellie, you are truly a diamond. Your inner strong character shines through, always helping others while fighting your own battles. You have such a way with words (I'm jealous) kind but straight to the point.

Thanks for reminding me that I'm still worth one more push in getting a 2nd opinion.

Sam xx

[SAMMY88]

Christopher, I've read so many articles about emg tests and the role they play in MND.

Yes I understand MND is a diagnosis by exclusion. Tho in my case over 20 months, I've only had 2 spine mri, and one emg test then told i have MND.

My understanding is that an emg test shows a certain pattern with MND/ALS that's arguably hard to deny.

That's for taking the time to reply to me, oh and I love your sense of humour. Anyone who loves cakes as much as me has my full respect but just so you know I never share cake 😏😁 xx

[Tabbycat]

With an EMG, there is much more information gained than a mere shadow on a radar: the type of aircraft, the number of engines and thrust generated and its cruising speed are all clearly identifiable, what's missing is the flight plan which the pilot has determined 😏😄

😂 Perfect summary.

[TinyLady]

Christopher - that article by Prof Turner frustrates me to death.... with a normal EMG he too will sit on the fence despite confirmed UMN, LMN and progressive symptoms and clinical signs with everything else (apparently) ruled out.